Goalies, Poets and Medical Students Fallibility and “the highway to success”

Jonathan Quick made a mistake.

Jonathan Quick

© http://wpmedia.o.canada.com/2013/10/quick.jpg?w=660&h=330&crop=1[i]

For those of you not familiar, Jonathan Quick is a professional hockey player.  Moreover, he is a goaltender.  Moreover still, he is one of the best goaltenders in the world.  Yes, I said world.   Last year, playing for the Los Angeles Kings, he amassed an impressive numbers of wins and statistics in all things relevant to goaltending, and was the most valuable player on a team that competed deep into the playoffs.  His accomplishments have been acknowledged in numerous ways, including being recognized recently by Sports Illustrated as one of the best four goalies in the National Hockey League and, perhaps most significantly, with a 10 year contract with Los Angeles said to be worth 58 million dollars.

Last Monday evening Jonathan was tending goal early in the third period of a home game against the New York Rangers.  His team was down 2-1 but on the power play, pressuring the Rangers for the tying goal.  One of the Rangers managed to nab the puck and send it into the Kings’ end of the rink.  Jonathan, alone in that half of the rink, came out of his net to play the puck, presumably to pass it up to one of his players to continue the power play.  In a manner later described as “comical” by a sports writer, he dropped his stick, misplayed the puck, attempted to recover with his blocker, but instead sent the puck slowly but inexorably into his own net, forced to watch it helplessly, along with the 20,000 or so folks in the arena, as well as most of the sporting world who would relive the moment repeatedly in broadcasts the next morning.  Perhaps most painful of all was Jonathan’s body language after this mishap – arms in the air, head down, clearly devastated.

Significant in all this was the reaction of his teammates and even opposing players.  Their manner at the time and in commentary afterward was in no way condemning, but rather sympathetic and supportive.  “Tough break”…”It could happen to any of us”.  Even the opposing goaltender, Hendrik Lundqvist, himself a stellar player, was quoted as saying “I feel for him”.

The message was clear.  Jonathan Quick is still one of the best goaltenders in the world.  What happened to him is regarded by those who labour in the same business as an occupational hazard in a profession that has no tolerance for error and very high public scrutiny.   To his lasting credit, Jonathan met with the press afterward and took responsibility for what had happened.  Regret, but no excuses.

One can’t help but draw a parallel to the medical profession, where adverse outcomes are regarded as “errors” and draw understandable scrutiny.  Doctors have always recognized the value of reviewing and studying cases where outcomes are anything less than optimal.  Those reviews must necessarily involve all aspects of the care delivery, from simple administrative process, through equipment performance to decision-making and technical provision of procedures.  Perfection, although never attainable in any human endeavour, must always be the goal.  Every adverse outcome provides a lesson and learning opportunity that makes the overall process safer and approaches that perfection.  Like poor Jonathan, alone, sprawled on the ice, physicians feel isolated and very responsible when events go badly, and struggle to interpret these in broader, depersonalized contexts, a necessary struggle if they are to learn and go on to provide care to their next patient.  The open acknowledgement and reporting of errors is a fundamental ethic, and legal responsibility of both the physician and profession.

Medical students begin this struggle very early.  Entering medical school with stellar and usually unblemished records of academic accomplishment, many students have great difficulty dealing with even minor “failures” in their course work or professional behaviour.  The ability to accept and even welcome feedback is a necessary professional competency and one of the most difficult to both teach and learn.  We are accustomed to success and the praise that comes with it.  Anything short of this is seen as a personal “failure” and something to be avoided and even contested.

My colleague Dr. Michelle Gibson likes to quote a particularly revealing study in which a group of medical students were randomized to receive feedback that was either laudatory but non-specific, or very specific and critical of their ability to perform a technical task, in this case tying surgical knots.  When asked to evaluate the value of their feedback, those who received laudatory feedback rated their feedback as much more valuable than those who’d been critically reviewed.  However, when assessed objectively with respect to their ability to tie knots at a follow-up test, the critically appraised students performed significantly better.  The tough medicine, it would appear, is more effective.

Teaching faculty struggle with providing feedback.  It’s much easier to praise and non-specifically encourage than to critique.  Finding ways to provide that critical feedback is equally challenging.  It’s not much help to simply say, “your knots aren’t very good, you should work on that”.  Pointing out the specific issue and even demonstrating correct technique takes time and patience, but will ultimately lead to real improvement.

None of this, of course, is surprising.  It’s the critical analysis and setbacks that help us improve and learn.  That lesson, however, is much more evident and easy to accept in mid or late career than it is to a novice learner.  Medical educators are in full agreement that the ability of a student to accept and assimilate criticism is a marker of both academic and career success.  The converse is equally true – that an inability to accept and grow from critical feedback is a marker of poor performance and poor behaviour in future years.  Humility, it would seem, is truly the beginning of wisdom, but it’s hard to be humble if you’ve never experienced or acknowledged failure.

The romantic poet John Keats (1795-1821) only lived to be 26 years of age, but in that time wrote the following: poet

“Don’t be discouraged by a failure. It can be a positive experience. Failure is, in a sense, the highway to success, inasmuch as every discovery of what is false leads us to seek earnestly after what is true, and every fresh experience points out some form of error which we shall afterwards carefully avoid.”

It may seem quite a stretch to connect a twenty-something English romantic poet of the early 19th century with 21st century hockey players and medical students of the same age, but the wisdom transcends both time and culture.

Jonathan Quick made a mistake.
Jonathan Quick is a great goaltender.
Last week, he got even better.

 

Image from:

[i] http://o.canada.com/sports/los-angeles-kings-jonathan-quick-deflects-puck-into-his-own-net/

2 Responses to Goalies, Poets and Medical Students Fallibility and “the highway to success”

  1. Richard Reznick says:

    Tony, Fantastic blog with a great message!

    Richard Reznick

  2. Sheila Pinchin says:

    This article has great learning for students, for clinicians and for teachers. As teachers, when we make a mistake, we are hard on ourselves as well. When I was assessing teacher-candidates at the Faculty of Education by observing them teach, they would be horrified and self-flagillating if they did something “wrong.” My response was always that we all make mistakes but the ability to recover from, deal with and learn from the mistakes is what makes a teacher great. Thanks for sending this message to all of us, through telling us how Jonathan Quick got even better!

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